Third waves of the COVID-19 pandemic: Prominence of initial public health Interference

Effect of Excess Mortality on Longevity During the COVID-19 Pandemic in South Asia

BACKGROUND

Throughout the twentieth century and beyond, a global trend of declining mortality rates and an increase in life expectancies was noted until the onset of the coronavirus disease 2019 (COVID-19) pandemic. A reduction in life expectancies was observed in most countries, including South Asia, during 2020 and 2021 due to the excess mortality caused by the pandemic.

OBJECTIVE

This study aims to examine the change in life expectancy in selected South Asian countries and the relative change in age- and sex-specific mortality rates over time due to the COVID-19 pandemic. In addition to that, we further examined the effect of a pandemic on a short-term forecast of life expectancy.

DATA AND METHODS

Estimated age- and sex-specific mortality rates of seven South Asian countries were utilised from the 2022 revision of the World Population Prospects (WPP 2022). Changes in life expectancies are estimated using standard life table estimation techniques. To estimate the relative change in age- and sex-specific mortality levels and change in mortality forecasts as a result of the pandemic, we applied the Lee-Carter method.

RESULTS

The application of the Lee-Carter model revealed age- and sex-specific variations in mortality improvements, reflecting heightened mortality rates within the region. This decline in mortality improvement is highly observed for both sexes in Pakistan, followed by India and Bangladesh. Populations exhibiting slower rates of improvement throughout their lifespan demonstrated minimal alterations attributable to the pandemic's impact. Comparative life expectancy forecasts indicate a slower rise in post-pandemic life expectancy at birth and in remaining life expectancies at older ages among most of these populations.

CONCLUSION

These findings highlight the pandemic's profound impact on mortality dynamics, emphasising the need for targeted interventions to mitigate its long-term effects on population health and longevity.

Exploring New COVID-19 Incertitude: JN.1 Variant- JN.1: The Queer Bird among Omicron Sublineages

The COVID-19 pandemic is casting a long shadow, and the appearance of the JN.1 variety calls attention to the necessity of maintaining heightened awareness. It considers the strength that has been developed via immunization programs and the necessity of global collaboration to find a solution in light of the emergence of new strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Phylogenetically, the SARS-CoV-2 Omicron XBB lineages, which include EG.5.1 and HK.3, are different from the SARS-CoV-2 BA.2.86 lineage, which was initially discovered in August 2023. More than 30 mutations in the spike (S) protein are carried by BA.2.86 compared to XBB and BA.2, suggesting a high potential for immune evasion. JN.1 (BA.2.86.1.1), appeared in late 2023 after the format had undergone evolution. JN.1 carries three mutations in proteins that do not include S, as well as S: L455S. As previously demonstrated, the HK.3 and other "FLip" variations possess the S: L455F mutation, which enhances transmissibility and immune escape capacity in comparison to the parental EG.5.1 variety. This mutation is a characteristic of JN.1. The COVID-19 virus is dynamic and evolves over time. New varieties can sometimes spread more quickly or effectively after these alterations. If that happens, the new variant has a chance to outpace the current varieties in terms of frequency.

Comparative Study of Pregnancy Outcomes in Women With COVID-19 Disease During the Three Waves of the Pandemic in Eastern India

Introduction Healthcare systems around the world were disrupted by the COVID-19 pandemic. Multiple waves were experienced by most countries, and clinical symptoms and severity varied between these waves. A COVID-19 infection in pregnant women may result in complications for both the mother and the fetus and thus pose an additional challenge for clinicians. The study of the different presentations, complications, and pregnancy outcomes during the three waves is important to study the effect of the disease on pregnant women. Objective This study aimed to analyze and compare the clinical presentations, comorbid conditions, complications, and pregnancy outcomes in women with SARS-CoV-2 infection during the three waves of the pandemic. Methodology The present study is a comparative study undertaken at Tata Main Hospital, a referral hospital in Jamshedpur in eastern India. The study period was from May 2020 to February 2022 and was divided according to the three waves of the pandemic. The duration of the first wave was between 1st May 2020 and 28th February 2021; the second wave was between 1st March 2021 and 31st October 2021; and the third wave was between 1st November 2021 and 28th February 2022. A total of 306 pregnant women tested positive for COVID-19 disease during the study period. A retrospective collection of data was done, and clinical findings, laboratory results, comorbid conditions, and outcomes were compared across the three waves. Results During the first wave of the pandemic, 139 COVID-19-positive pregnant women were admitted to our hospital. During the second wave, 110 admitted pregnant women tested positive for SARS-CoV-2 infection, and during the third wave, 57 pregnant women tested positive for SARS-CoV-2 infection. Asymptomatic or mild disease was the most commonly seen presentation during all the waves, but a significantly higher number of moderate and severe cases were seen during the second wave. The second wave also witnessed a higher rate of cesarean sections when compared to the other two waves. The preterm delivery rate was 27.8%, 24.7%, and 25% during the first, second, and third waves of the pandemic, respectively. The third wave of the pandemic had the highest percentage of stillbirths, which was significantly higher than both the first and second waves. The COVID-19 test was positive in four babies during the study period. Conclusion The severity of COVID-19 disease varied among the three waves, and the second wave recorded the maximum number of moderate and severe cases. Maternal mortality was also significantly higher during the second wave. The rate of preterm deliveries was high during all the waves, and the incidence of stillbirths was highest during the third wave.

Predicting Mortality for COVID-19 Patients Admitted to an Emergency Department Using Early Warning Scores in Poland

COVID-19 disease is characterised by a wide range of symptoms that in most cases resemble flu or cold. Early detection of infections, monitoring of patients' conditions, and identification of patients with worsening symptoms became crucial during the peak of pandemic. The aim of this study was to assess and compare the performance of common early warning scores at the time of admission to an emergency department in predicting in-hospital mortality in patients with COVID-19. The study was based on a retrospective analysis of patients with SARS-CoV-2 infection admitted to an emergency department between March 2020 and April 2022. The prognostic value of early warning scores in predicting in-hospital mortality was assessed using the receiver operating characteristic (ROC) curve. Patients' median age was 59 years, and 52.33% were male. Among all the EWS we assessed, REMS had the highest overall accuracy (AUC 0.84 (0.83-0.85)) and the highest NPV (97.4%). REMS was the most accurate scoring system, characterised by the highest discriminative power and negative predictive value compared to the other analysed scoring systems. Incorporating these tools into clinical practice in a hospital emergency department could provide more effective assessment of mortality and, consequently, avoid delayed medical assistance.

Anti-SARS-CoV-2 antibody kinetics up to 6 months of follow-up: Result from a nation-wide population-based, age stratified sero-epidemiological prospective cohort study in India

Repeated serological testing tells about the change in the overall infection in a community. This study aimed to evaluate changes in antibody prevalence and kinetics in a closed cohort over six months in different sub-populations in India. The study included 10,000 participants from rural and urban areas in five states and measured SARS-CoV-2 antibodies in serum in three follow-up rounds. The overall seroprevalence increased from 73.9% in round one to 90.7% in round two and 92.9% in round three. Among seropositive rural participants in round one, 98.2% remained positive in round two, and this percentage remained stable in urban and tribal areas in round three. The results showed high antibody prevalence that increased over time and was not different based on area, age group, or sex. Vaccinated individuals had higher antibody prevalence, and nearly all participants had antibody positivity for up to six months.

Assessment of SARS-CoV-2 Infected Patients and Their Clinical Outcomes During the Third Wave in India: A Single-Center Observational Study

Background

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that emerged from the Chinese mainland has spread throughout the world affecting the normal lives of the people. Both developed and developing nations have been equally affected and coronavirus disease-19 (COVID-19) resulted in the death of millions of people worldwide. The virus is undergoing mutations and is evolving into variants that are responsible for wave after wave. This study was carried out to assess the clinical outcomes of people infected with the novel virus during the third wave of the COVID-19 pandemic in India.

Methods

The study was carried out between November 2021 and January 2022 and included 100 consecutive patients attending the hospital attached to the BLDE (Deemed to be University) Shri B.M. Patil Medical College, Bijapur, Karnataka, South India. All patients included in the study returned a positive report in a real-time polymerase chain reaction (RT-PCR). The patient details collected included age, sex, cycle threshold (Ct) values for envelope (E)/nucleocapsid (N), and Orf1b (open reading frame 1b) genes, hospitalization status, vaccine status, C-reactive protein (CRP), D-dimer, interleukin-6 (IL-6), and final clinical outcome. The data were entered into Microsoft Office Excel sheets, and statistical inferences were drawn using SPSS 24 (IBM Corp., Armonk, NY).

Results

Of the 100 patients included in the study, only 14 (14%) patients were vaccinated. The patient's mean age was 34.22±17.50. Among the vaccinated patients, the majority had taken COVISHIELD™ (85.71%) compared to COVAXIN^® (14.29%). Only 14% of patients were symptomatic, and the mean Ct values among all the patients were 29.92±3.74 (E gene/N gene) and 27.6±4.78 (Orf1B gene). Eight (8%) patients were hospitalized, and all the patients recovered from the infection. Among the hospitalized patients, six (75%) were vaccinated. The mean age of the hospitalized patients was 43.8±14.25 years. The mean CRP, D-dimer, and IL-6 concentrations among the hospitalized patients were noted to be 22.375±16.58 mg/L, 654.325±577.24 ng/mL, and 5.075±2.15 ng/mL, respectively.

Conclusion

The study results demonstrate that despite unvaccinated status, most patients in the third wave had only suffered from asymptomatic infection. Moreover, people who developed a clinical infection and those who required hospitalization had an uneventful recovery irrespective of their vaccination status.